Hegde John V, Demanes D Jeffrey, Veruttipong Darlene, Raince Jagdeep, Park Sang-June, Raman Steven S, Nickols Nicholas G, King Christopher R, Kishan Amar U, Steinberg Michael L, Kamrava Mitchell
Department of Radiation Oncology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA.
Department of Radiation Oncology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA.
Brachytherapy. 2017 Nov-Dec;16(6):1106-1112. doi: 10.1016/j.brachy.2017.07.008. Epub 2017 Aug 12.
To determine whether pretreatment 3T multiparametric MRI (mpMRI) staging impacts biochemical recurrence-free survival (BRFS) or distant metastasis-free survival (DMFS) for men with high-risk prostate cancer treated with combination high-dose-rate (HDR) brachytherapy and external beam radiation therapy (EBRT).
This institutional review board-approved retrospective study included a cohort of 37 men with high-risk prostate cancer treated with HDR brachytherapy and EBRT after 3T mpMRI. Kaplan-Meier analysis was used to evaluate whether mpMRI evidence of extracapsular extension or seminal vesicle invasion (SVI) resulted in differences in BRFS or DMFS. Pretreatment and treatment-related variables were evaluated for association with biochemical failure (Phoenix definition) and distant metastatic failure using univariate Cox regression analysis.
The median prostate-specific antigen at diagnosis was 9 ng/mL (range 2-100). Biopsy Gleason score (bGS) was ≤8 in 38% and nine in 62%. Clinical T-category was T1-T2 in 89%, T3a in 8%, and T3b in 3%. With a median followup of 30.6 months, actuarial 3-year BRFS and DMFS were 76% and 86%, respectively. Kaplan-Meier analysis revealed that mpMRI evidence of extracapsular extension or SVI resulted in significantly higher rates of both biochemical recurrence and distant failure. Using Cox regression analysis, only mpMRI evidence of SVI vs. no SVI predicted for biochemical failure (hazard ratio 13.98, p = 0.0055).
For high-risk prostate cancer treated with combination HDR brachytherapy and EBRT, mpMRI evidence of SVI predicted for biochemical failure, whereas traditional pretreatment variables did not. Therefore, pretreatment 3T mpMRI appears useful for identifying men who may benefit from treatment intensification.
确定对于接受高剂量率（HDR）近距离放射治疗和外照射放疗（EBRT）联合治疗的高危前列腺癌男性患者，治疗前3T多参数磁共振成像（mpMRI）分期是否会影响无生化复发生存期（BRFS）或无远处转移生存期（DMFS）。
这项经机构审查委员会批准的回顾性研究纳入了37例高危前列腺癌男性患者队列，这些患者在接受3T mpMRI检查后接受了HDR近距离放射治疗和EBRT。采用Kaplan-Meier分析评估mpMRI显示的包膜外扩展或精囊侵犯（SVI）证据是否会导致BRFS或DMFS出现差异。使用单因素Cox回归分析评估治疗前和治疗相关变量与生化失败（凤凰定义）和远处转移失败的相关性。
诊断时前列腺特异性抗原的中位数为9 ng/mL（范围2 - 100）。活检Gleason评分（bGS）≤8分的占38%，9分的占62%。临床T分期为T1 - T2的占89%，T3a的占8%，T3b的占3%。中位随访时间为30.6个月，3年精算BRFS和DMFS分别为76%和86%。Kaplan-Meier分析显示，mpMRI显示的包膜外扩展或SVI证据导致生化复发和远处转移失败的发生率显著更高。使用Cox回归分析，只有mpMRI显示的SVI与无SVI证据可预测生化失败（风险比13.98，p = 0.0055）。
对于接受HDR近距离放射治疗和EBRT联合治疗的高危前列腺癌患者，mpMRI显示的SVI证据可预测生化失败，而传统的治疗前变量则不能。因此，治疗前3T mpMRI似乎有助于识别可能从强化治疗中获益的男性患者。
